Hognestad Aina, Endresen Knut, Wergeland Ragnhild, Mellembakken Jan R, Mollnes Tom E, Omland Torbjørn, Kjekshus John K, Aukrust Pål, Andreassen Arne K
Department of Cardiology, Rikshospitalet, University of Oslo, Norway.
J Heart Lung Transplant. 2005 Aug;24(8):1026-32. doi: 10.1016/j.healun.2004.07.018.
The clinical benefit of percutaneous coronary intervention (PCI) in heart transplant recipients (HTRs) with coronary allograft vasculopathy (CAV) has been questioned. We investigated the degree of inflammatory reaction during PCI in CAV compared to patients with native atherosclerosis, and the possible relationship between PCI-induced inflammation and the degree of re-stenosis in these 2 patient groups.
In 11 CAV patients and 10 patients with native atherosclerosis, blood samples were drawn before and 24 hours and 6 months after PCI, and analyzed with regard to hsCRP, MCP-1, components of complement activation, von Willebrand factor (vWf), soluble L-selectin and ICAM-1. Quantitative angiography was performed before and after PCI, and at 6-month follow-up.
Baseline levels of hsCRP, vWf and MCP-1 were significantly elevated and levels of L-selectin and ICAM-1 and activation products of the alternative pathway of the complement system were decreased in CAV patients compared to those with native atherosclerosis. PCI induced significant increases of hsCRP in both groups as well as an increase in vWf in native atherosclerosis, whereas a decrease in L-selectin was observed in native atherosclerosis. Plasma levels of MCP-1 correlated with percent stenosis at follow-up in both groups, whereas a correlation between hsCRP and percent stenosis was evident only in patients with native atherosclerosis. There were no differences in rates of re-stenosis between the 2 groups.
HTRs with CAV and patients with native atherosclerosis are characterized by different profiles of immune activation and respond differently to PCI. Nevertheless, an inappropriate inflammatory reactivity may predispose to re-stenosis after PCI in both groups of patients, with pre-procedural inflammation being of particular importance in CAV.
经皮冠状动脉介入治疗（PCI）对患有冠状动脉移植血管病变（CAV）的心脏移植受者（HTRs）的临床益处受到质疑。我们研究了与原发性动脉粥样硬化患者相比，CAV患者PCI期间的炎症反应程度，以及PCI诱导的炎症与这两组患者再狭窄程度之间的可能关系。
对11例CAV患者和10例原发性动脉粥样硬化患者，在PCI术前、术后24小时和6个月采集血样，分析高敏C反应蛋白（hsCRP）、单核细胞趋化蛋白-1（MCP-1）、补体激活成分、血管性血友病因子（vWf）、可溶性L-选择素和细胞间黏附分子-1（ICAM-1）。在PCI术前、术后及6个月随访时进行定量血管造影。
与原发性动脉粥样硬化患者相比，CAV患者hsCRP、vWf和MCP-1的基线水平显著升高，L-选择素和ICAM-1水平以及补体系统替代途径的激活产物降低。PCI使两组患者的hsCRP均显著升高，原发性动脉粥样硬化患者的vWf升高，而原发性动脉粥样硬化患者的L-选择素降低。两组患者血浆MCP-1水平与随访时的狭窄百分比相关，而hsCRP与狭窄百分比之间的相关性仅在原发性动脉粥样硬化患者中明显。两组患者的再狭窄率无差异。
患有CAV的HTRs和原发性动脉粥样硬化患者具有不同的免疫激活特征，对PCI的反应也不同。然而，不适当的炎症反应可能使两组患者PCI术后易发生再狭窄，术前炎症在CAV中尤为重要。
